Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

METHODS

The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.

FINDINGS

Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021.

INTERPRETATION

Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.

FUNDING

Bill & Melinda Gates Foundation.

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021.

METHODS

The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk-outcome pairs. Pairs were included on the basis of data-driven determination of a risk-outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk-outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk-outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws.

FINDINGS

Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7-9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4-9·2]), smoking (5·7% [4·7-6·8]), low birthweight and short gestation (5·6% [4·8-6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8-6·0]). For younger demographics (ie, those aged 0-4 years and 5-14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9-27·7]) and environmental and occupational risks (decrease of 22·0% [15·5-28·8]), coupled with a 49·4% (42·3-56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9-21·7] for high BMI and 7·9% [3·3-12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6-1·9) for high BMI and 1·3% (1·1-1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4-78·8) for child growth failure and 66·3% (60·2-72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP).

INTERPRETATION

Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions.

FUNDING

Bill & Melinda Gates Foundation.

Virgin coconut oil - its methods of extraction, properties and clinical usage: a review

Abstract

Virgin coconut oil (VCO) is a processed edible oil, which is removed from the mature coconuts. It is a colourless water insoluble liquid and obtained by the hot and cold extraction processes. The nutritional components of VCO are mainly contributed to by lauric acid, its primary content. VCO has shown its anticancer, antimicrobial, analgesic, antipyretic and antiinflammatory properties. Because of these medicinal properties, VCO has gained the wider attention among the medical field. Most evidently VCO has shown its potential antioxidant property, because of its phenolic compounds and medium chain fatty acids. It is one of the beneficial compounds used to prevent and treat the oxidative stress induced neurological disorders like stress, depression and Alzheimer's disease. Dietary supplementation of VCO is easy and economical and safer in daily life among all age groups. It is also beneficial for the cardiovascular, respiratory, dermatological, reproductive and bone health. It can also be applied to the skin as a moisturizer in the paediatric age group. Hence, exploration of antioxidant property as well as other beneficial effects of VCO in various health conditions will be valuable.

Delineation of Subarachnoid Cisterns Using CT Cisternography, CT Brain Positive and Negative Contrast, and a Three Dimensional MRI Sequence: A Pictorial Review

The basic anatomy and morphology of subarachnoid cisterns of the brain are interesting and challenging topics with high clinical significance. These enlarged CSF-filled expansions are important as they transmit various neurovascular structures. The cisterns can be classified based on their location as supratentorial, at the level of the tentorium, and infratentorial. They are also classified as paired and unpaired cisterns. The anatomical and radiological information about the cisterns is clinically and surgically relevant in diagnosing and managing many neurological disorders. It is also essential in medical teaching. This pictorial essay reviews the radiological images where the subarachnoid cisterns are delineated in four unique circumstances.

Dimensions of pes anserinus of the lower extremity, an anatomical study with its surgical implications

The reconstructive surgeries utilize pes anserinus (PA) tendons, because of their lesser post-operative clinical deficits and donor site morbidity. These surgeries require anatomical knowledge about the extent of PA formation. The goal of this study was to determine the length and width of the PA formation. The objectives were to measure the distance of its upper limit, lower limit, and vertical distance from the tibial tuberosity (TT). The present descriptive cross sectional study included 53 embalmed cadaveric lower extremities. The upper and lower limits of PA were exposed with the careful dissection. Measurements of the dimensions were performed with the help of a digital vernier caliper (Mitutoyo Co., Kanagawa, Japan). The PA length, width, distance of its upper limit, lower limit, and vertical distance of it from the TT were 47.4±13.3 mm, 37.3±7.2 mm, 47.6±12.5 mm, 54.6±10.4 mm, and 39.1±14.2 mm, respectively over the right extremity. The same measurements were 46.3±14.7 mm, 39.1±9.4 mm, 39.1±5.9 mm, 49.5±8.2 mm, and 36.4±12.1 mm, respectively for the left extremity. The extent of PA was observed to be extremely variable. The preoperative knowledge about the dimensions of PA will help the plastic and orthopedic surgeon put the accurate skin incision, decreasing the donor site morbidity and biomechanical instability of the PA grafts. We suggest that, preoperative ultrasound measurement of the PA may help the operating surgeon to prevent the complications like injury to the infrapatellar branch of saphenous nerve.

Exploring the Morphology of Anterior Interosseous Nerve and Relating It to Its Clinical Conditions

AIM

To study topography and variability in the origin of anterior interosseous nerve; to identify the branching pattern of the anterior interosseous nerve supplying the flexor digitorum profundus, flexor pollicis longus, and pronator quadratus muscles.

MATERIAL AND METHODS

The present study included 70 formalin-fixed upper limbs of adult human cadavers. The origin of the anterior interosseous nerve was categorized into 3 types. The morphometric data obtained in this study were represented as mean± SD and the dimensions were given in millimeter. The measurements were compared statistically by using 'EZR software, version 1.38, 2019'. The 'paired t-test' was applied and the 'p' value less than 0.05 was considered as statistically significant.

RESULTS

It was observed that the origin of the anterior interosseous nerve was extremely variable. It was ranging from the midepicondylar point of the elbow joint up to as below as 86mm from it. The distance of its origin from the midpoint of the pronator teres muscle ranged between 70 mm above the pronator teres muscle to 22 mm below it. In one of the forearms, the median nerve supplied the medial two tendons of the FDP, instead of the ulnar nerve.

CONCLUSION

The present study provided additional information about the origin, topography, and distribution of the anterior interosseous nerve. The data will provide further insight into the causes of nerve compression syndromes. It will also help in planning the surgical approach into the distal humerus, elbow joint, and proximal ends of radius and ulna, without causing any nerve injury.

Unique case of duplex interventricular branching from the left coronary artery

We report a rare morphological variant of the left coronary artery in this case of a female embalmed cadaver, where in the heart was nourished by double anterior and posterior interventricular arteries. These were branches of the left coronary artery and it was also observed that distribution of right coronary artery was very limited. The deceased may have been without symptoms in her life, but a prior knowledge of this kind of presentation would be very much informative to the interventional cardiologist and cardiothoracic surgeons in their protocol of treatment. This has implications for the coronary angiography and subsequent management of the ischemic heart disease.

Anatomical mapping of the biliary tree during laparoscopic cholecystectomy by using indocyanine green dye

Background:

Fluorescent cholangiography using intravenous indocyanine green (ICG) is a noninvasive technique that enables real-time intraoperative imaging of biliary anatomy. The objective of this study was to visualise the biliary anatomy in routine and complicated cases of laparoscopic cholecystectomy (LC).

Methods:

This was a prospective observational study of patients undergoing LC for various indications. After obtaining consent, 5 mg/1 ml of ICG dye was administered intravenously in each patient, 2 h before the incision time. LC was performed by standard critical view of the safety technique. The biliary tree was visualised using near-infrared (NIR) view before clipping any structure. Intra-operative findings, visibility of ducts in the NIR view, conversion, adverse reactions to ICG and post-operative outcomes in all patients were recorded.

Results:

Out of 43 patients undergoing LC, 24 had cholelithiasis, 10 had acute cholecystitis, 3 had chronic cholecystitis, 1 had mucocele of the gall bladder, 1 had gall bladder polyp and 4 cases had common bile duct (CBD) stone clearance with endoscopic retrograde cholangiopancreatography. Cystic duct (CD) and CBD were visualised in 100% of cases among all groups except for those with acute cholecystitis where CD and CBD were visualised in 90% and 80% of cases, respectively, and in chronic cholecystitis CD and CBD were visualised in 66.6% and 80% of patients, respectively. There was one elective conversion in the chronic cholecystitis group due to dense adhesions and non-progression. Only the CBD was visualised in this case. There were no cases of CBD injury or any allergic reactions to the dye.

Conclusions:

Fluorescent cholangiography during LC is a safe and non-invasive method, allowing superior anatomical visualisation of the biliary tree in comparison to simple laparoscopy. This method can correct misinterpretation errors and detect aberrant duct anatomy, thus increasing the confidence of the operating surgeon enabling safe dissection. This simple technique has the potential to become standard practice to avoid bile duct injury during LC.

A case of inferior alveolar nerve encircling the arteria maxillaris

Here we report a case of inferior alveolar nerve (IAN), which had variability in its formation. IAN was formed by dual roots, which were branching out from the posterior division of mandibular nerve. The observed roots were forming a loop around the pterygoid part of arteria maxillaris (MA). One of the roots was superficial to the MA and the other was deep to it. It is believed that this type of morphological variation in the formation of IAN can have clinial implications, which include compression by adjacent structures and nerve entrapment. The knowledge of this variation is important to anaesthesiologists and dentists, while administering local anaesthesia. This is also enlightening to the maxillofacial surgeons, neurologists and radiologists.

Neuroprotective effects of resveratrol in Alzheimer's disease

Alzheimer's disease (AD) is a neurodegenerative disorder, which is commonly seen in older individuals. This is characterized by cognitive dysfunction, which leads to dementia. Pharmacological treatments for AD are mainly targeted on its symptoms like memory loss and cognitive impairment. The pathophysiology involved in AD is intra-neuronal accumulation of hyper-phosphorylated tau protein as neurofibrillary tangle and extra cellular beta amyloid plaque deposition, which is due to oxidative stress. Here we review the neuro-protective effects of Resveratrol (RSV) and its treatment efficacy in AD. RSV is a naturally available polyphenolic compound, which has antioxidant, anti-cancerous, anti-inflammatory and anti-aging properties. RSV crosses blood brain barrier and exerts its antioxidant effect by enhancing the anti-oxidant enzymes. RSV is involved in Sirtuin (SIRT1) mediated lifespan extension activity. RSV has reduced glial activation and helped in increasing the hippocampal neurogenesis. RSV was able to decrease the expression of amyloid precursor protein, along with improvement of spatial working memory. Since RSV acts as an antioxidant, it can be safely used as oral drug.

In vivo magnetic resonance imaging morphometry of the patella bone in South Indian population

Racial differences exist in the dimensions of structures and the commercially available prostheses are designed based on the Caucasians. In this context, the goal of the present investigation was to determine the gender wise measurements of patella bone in South Indians. The present study included axial magnetic resonance images of the knee joint from 140 South Indian adults (70 males, 70 females; aged between 20–70 years). The angle, width, thickness, lateral facet width, facet thickness, ratio of the lateral facet, the relative thickness and ratio of facet thickness were measured in the patella by using the digital ruler. The statistical analysis was performed by using the SPSS software. The dimensions exhibited statistically highly significant sexual dimorphism (P≤0.001). The mean value was higher in males than females except for the ratio of patellar lateral facet and patellar facet thickness ratio. It was observed that the males exhibit more variability than females in all the measurements of patella except patellar thickness, patellar facet thickness, patellar relative thickness, and patellar facet thickness ratio. The present study of the in vivo morphometry of patella bone from the South Indians can provide a population and gender specific database for the morphometric measurements of the patella. We believe that the data of the present study will be useful to the orthopaedician during the procedures like arthroplasty of the total knee, patellofemoral arthroplasty, resurfacing of patella, and designing the prosthetic implant.

Lobed spleen: an autopsy case report with emphasis on surgical anatomy

During the medico-legal autopsy of a male aged 45 years, a bilobed morphology of the spleen was observed. An oblique fissure was located longitudinally at the mid-region of the diaphragmatic surface of the spleen. The fissure was partially deep and observed throughout the diaphragmatic surface. The clinician should be aware of the developmental anomalies of the spleen; as such anomalies may cause confusion during the procedures like splenic biopsy and splenectomy. We believe that, the present case report is important to the radiologists and clinicians involved in the diagnosis and management of splenic pathology. The knowledge is also enlightening to the morphologists and embryologists. The radiologist and clinician should make sure that the fissure in a spleen is not misinterpreted as a laceration or rupture.

MORPHOMETRY OF THE PEDICLE OF FIRST SACRAL VERTEBRAE AND ITS APPLICATION IN POSTERIOR TRANSPEDICULAR SCREW FIXATION. Morfometría del pedículo de la primera vértebra sacra y su aplicación en la fijación posterior con tornillo transpedicular

Los objetivos del presente estudio fueron determinar los parámetros anatómicos del pedículo S1 en la población India del sur para comparar los datos con respecto a los géneros masculinos y femeninos. El estudio incluyó 50 sacros secos (25 hombres y 25 mujeres) que se obtuvieron en el laboratorio de anatomía de nuestra institución. En el presente estudio se observa que la longitud media del pedículo S1 fue 49.9± 3,6 mm para los hombres y 46.3± 4,8 mm para las mujeres. La altura céfalo-caudal del pedículo S1 fue 27.2±4.0 mm y 23.9±3.7 mm para el varón y la hembra respectivamente. La anchura antero-posterior del pedículo S1 fue 7.5± 1,3 mm, 7.5± 1.7 mm en varones y mujeres, respectivamente. La distancia antero-posterior de S1, desde el promontorio sacro a la apófisis espinosa de S1 fue 52.9± 5.2 mm y 50.4± 6.8 mm en los géneros masculino y femenino respectivamente. El presente estudio demostró que la longitud y la altura de céfalo-caudal eran más altos (p0.05) en varones que en mujeres. Los datos de mujeres y varones con respecto a la anchura antero-posterior y la distancia antero-posterior de S1 no eran estadísticamente diferentes. El presente estudio ha proporcionado datos morfométricos importantes del pedículo de la primera vértebra sacra de la muestra anatómica de la población India del sur. El conocimiento de los diámetros del pedículo de S1 es crucial para la colocación segura de tornillos para la fijación transpedicular posterior. Objectives of the present study were to determine the anatomical parameters of the S1 pedicle in South Indian population and to compare the data, with respect to male and female genders. The stud­­y included 50 dry sacra (25 male and 25 female), which were obtained from the anatomy laboratory of our institution. It is observed in the present study that the mean S1 pedicle length was 49.9± 3.6 mm for male and 46.3± 4.8 mm for the female. The cephalocaudal heights of S1 pedicle were 27.2±4.0 mms and 23.9±3.7 mms for the male and female respectively. The anteroposterior width of S1 pedicle was 7.5± 1.3 mms, 7.5± 1.7 mms in males and females respectively. The anteroposterior distances of S1, from the sacral promontory to the spinous process of S1 were 52.9± 5.2 mms and 50.4± 6.8 mms respectively for the male and female genders. The present study observed that the mean S1 pedicle length and the cephalocaudal height were higher (p<0.05) for the males than that of females. The data (male vs female) were not found statistically different (p>0.05), with respect to the anteroposterior width of the S1 pedicle and the anteroposterior distances of S1 from the sacral promontory to the spinous process of S1. The present study has provided important morphometric data onto the pedicle of the first sacral vertebrae, from the anatomical samples of the South Indian population. The knowledge of pedicle diameters of S1 is crucial to the safe placement of screws in the posterior transpedicular screw fixation.

Morphology and topography of the parietal emissary foramina in South Indians: an anatomical study

The objectives of the present study were to study the prevalence of the parietal emissary vein in adult South Indian population and to study the distance of foramen from the sagittal suture. There were 58 adult human skulls in the present study which were available at the anatomy department of our institution. The study included 116 parietal bones which have been observed macroscopically for the number, prevalence and topography of the emissary foramen. The emissary foramen was present in 83 parietal bones (71.5%) of the present study. It was present at the junction between the middle 1/3 and posterior 1/3 region of the parietal bone. The foramen was observed solitary in 73 parietal bones (62.9%), double in 8 bones (6.9%), and triple in 2 parietal bones (1.7%). The foramen was not observed in 33 parietal bones (28.4%). The bilateral absence of parietal emissary foramen was seen in 7 skulls (12.1%). It was absent unilaterally in 19 skulls (32.7%). The accessory foramina were seen in only 8 skulls (13.8%). The mean distance of the foramen from the sagittal suture was 6.7±2.9 mm and 6.8±2.8 mm on the right and left sides respectively. The prevalence of parietal emissary vein in the present study was 71.5%. The present study has observed important data about the morphology and morphometry of the parietal emissary vein in South Indian population. The identification of parietal emissary veins and accessory veins is important in the operation room to prevent the blood loss.

The Paracondylar Skull Base: Anatomical Variants and Their Clinical Implications

AIM

The knowledge of the vasculature around the paracondylar region is important in neurosurgical procedures such as the paracondylar and lateral supracondylar approaches. The objectives of the present study were to determine the prevalence of paracondylar emissary foramina in the adult skull bases and to study the morphology of condylar canals and hypoglossal canals.

MATERIAL AND METHODS

The present study included 48 adult human skulls that were obtained from the gross anatomy laboratory of our institution. The paracondylar region was macroscopically observed for the variant foramina, canals and grooves.

RESULTS

It was observed that the paracondylar emissary foramen was present in 16 skulls (33.3%). The foramen was found bilaterally in 7 skulls (14.6%) and unilaterally in 9 skulls (18.7%). The hypoglossal canal was single in 35 (72.9%) skulls, double in 11 skulls (22.9%), and triple in 2 skulls (4.2%). The paracondylar process (2.1%) and the paracondylar groove (2.1%) were seen in 1 skull each. The posterior condylar canal was found to be patent in 19 (39.6%) skulls.

CONCLUSION

The present study observed that, the paracondylar emissary vein is not rare in occurrence as it is observed in 33.3% of cases. The identification of the paracondylar emissary veins and accessory vessels is important to avoid dangerous bleeding during the surgery. The morphological knowledge of the foramina around the paracondylar region is enlightening to the chiropractors, neurosurgeons and radiologists.

Morphological study of styloid process of the temporal bone and its clinical implications

The objective of this study was to study the morphometry of the styloid process of temporal bone and prevalence of elongated styloid process. The morphology of elongated styloid process along with its embryological and clinical importance are discussed. The present study included 110 human dry skulls which were procured from the bone collections of the department of anatomy. The styloid process was observed macroscopically on both sides of all the skulls, the elongations if any were noted. All the styloids were measured for their length, thickness at different levels and interstyloid distance at various levels. Out of 110 specimens, only 5 skulls (4.5%) exhibited the elongated styloid process. Among them, 3 skulls (2.7%) had unilateral elongation and 2 skulls (1.8%) had bilateral elongation of the styloid process. The mean length of the styloid process was 17.8±9.3 mm and 18.2±5.6 mm for the right and left sides, respectively. The prevalence of elongated styloid process in the present study was 4.5%. The clinical anatomy of this congenital variant is important to the neurosurgeon and radiologist, while interpreting the computed tomogram and magnetic resonance image scans. The morphological knowledge of elongated styloid process is clinically important since the course of the vertebral artery may be distorted in such situations.

Arterial supply to the soleus muscle: an anatomical study with emphasis on its application in the pedicle flap surgery

PURPOSE

To study the various patterns in the extra muscular part of arterial supply to the soleus muscle.

METHODS

The study was carried out using 38 adult cadaveric lower limbs which were available from the Department of Anatomy of our institution. The vascular branches to the soleus were identified and traced till their point of entry into the soleus. These were considered as extramuscular branches (EMB) to the soleus. The distances of first and last branches from each artery were measured from the apex of head of fibula to their point of entry into the soleus and were expressed as proportion to the length of soleus.

RESULTS

The present study observed that the soleus muscle is supplied by EMB of popliteal, posterior tibial and peroneal arteries. In 42.1% cases, there was no direct EMB from the popliteal artery to the soleus. The EMB of popliteal artery were located between 3.2 and 24.6% of the length of soleus. The EMB from the posterior tibial and peroneal arteries were located between 6.8-97.1% and 5.7-94.9% of the length of soleus, respectively. The proximal 25% of length of soleus received EMB from all the three arteries.

CONCLUSIONS

The present study has provided additional information on the various patterns in the extra muscular part of arterial supply to the soleus muscle. This knowledge is important to the plastic and orthopedic surgeons while performing the pedicle flap surgeries. Our opinion is that the proximally based soleal muscle flaps are more beneficial in the surgical practice.

In vivo morphometry of menisci of the knee in South Indians: a preliminary study

BACKGROUND

Since the in vivo morphometric data on the menisci of the knee joint of Indian subjects are scarce, we hereby studied the width and thickness of the menisci using Magnetic Resonance Imaging (MRI) to establish standard dimensions of the normal medial and lateral meniscus as an aid to orthopaedic surgery.

METHODS

Eighty menisci from 40 knee joints were analysed in each of three regions, the anterior horn, the mid body and the posterior horn. The thickness and width of the menisci were measured in sagittal and coronal T1-weighted and T2-weighted MRI images and analysed statistically.

RESULTS

The mean thickness of medial meniscus at the anterior horn, mid body, and posterior horn were 6.3 ± 1.1 mm, 5.2 ± 1.3 mm, and 6.9 ± 1.1 mm, respectively. The respective values for the lateral meniscus were 4.8 ± 0.7 mm, 6.4 ± 1.1 mm, and 7.0 ± 0.9 mm. The mean width of medial meniscus at the anterior horn, mid body, and posterior horn were 10.5 ± 1.2 mm, 7.8 ± 1 mm and 13.9 ± 0.9 mm, respectively. The widths of lateral meniscus at the same regions were 11.8 ± 1.4 mm, 8.6 ± 1.2 mm, and 12.0 ± 0.9 mm, respectively. The lateral meniscus was significantly wider than medial at the anterior horn and mid body (p = 0.00). In contrast, the posterior horn of medial meniscus was significantly wider than lateral meniscus. Both menisci were significantly wider at their posterior horn, followed by the anterior horn and were significantly narrower at their mid body.

CONCLUSION

The present study provides new information on the meniscal thickness and width in South Indians that can be used in planning of orthopaedic and arthroscopic surgeries of the knee joint. However, the study needs to be analyzed with a large sample size for the better interpretation.

Mastoid emissary foramina: an anatomical morphological study with discussion on their evolutionary and clinical implications

The identification of mastoidal emissary veins is of importance in the neurosurgical practice to diagnose abnormal and normal structures. In the present study, the objectives were to estimate the prevalence rate of mastoidal emissary foramina in the temporal bones of the adult skull and to study their number and morphology. The present study included 48 adult human skulls which were obtained from the gross anatomy laboratory of our institution. The mastoid parts of 96 temporal bones were macroscopically observed for the prevalence, number and morphology of the emissary foramina. It is observed that, the mastoidal emissary foramen was present in 88 temporal bones (91.7%) of our specimens. The foramen was observed single in 60 temporal bones (62.5%), double in 22 bones (22.9%), and triple in 6 temporal bones (6.2%). The mastoidal emissary foramen was absent in 8 (8.3%) temporal bones. The foramen was bilaterally absent in 3 (3.1%) skulls. It was unilaterally absent in 2 (2.1%) skulls and both were on the left side. The mastoidal emissary vein is prevalent in a large number (91.7%) of cases. It was observed that the accessory mastoidal emissary foramina were present in 29.1% of cases. Recognition of the mastoid emissary veins and accessory mastoid emissary veins during the otologic surgery is critical to avoid the significant bleeding. In the neurosurgical practice, the knowledge is important due to variability in the number of mastoidal emissary veins and their connection to the venous sinuses.

Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications

During the routine dissection of upper limbs of a Caucasian male cadaver, variations were observed in the brachial plexus. In the right extremity, the lateral cord was piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited the passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of humerus. A variation in the course and branching of the nerve might lead to variant or dual innervation of a muscle and, if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both clinical diagnosis and surgical practice.

Synostosis of dorsolumbar spine: an anatomical investigation with emphasis on clinical and embryological details

PURPOSE

The objectives were to study the morphology of fused vertebrae in thoracolumbar region.

MATERIALS AND METHODS

The study included 729 thoracolumbar vertebrae which were macroscopically observed for the fusion and morphological details were observed.

RESULTS

It was observed that, there was fusion in three of our specimens. One specimen was having fusion between the two typical thoracic vertebrae. The other one had fusion among the three typical thoracic vertebrae. The third specimen had fusion between the twelveth thoracic vertebrae and the first lumbar vertebra. The average length of body of thoracic vertebrae was 1.8 mms, vertebral foramen diameter was 1.4 mms, length of lamina was 1.9 mms and the length of spinous process was 2.6 mms. The same parameters for the fused vertebrae of two typical thoracic was 3.2 mms, 1.1 mms, 4 mms and 4.7 mms respectively. The parameters of fused three typical thoracic vertebrae were 5.2 mms, 1.4 mms, 6.6 mms and 7.9 mms respectively. The average morphometric parameters of the fused thoracolumbar vertebrae were 3.7 mms, 1.4 mms, 4 mms and 3.5 mms respectively.

CONCLUSIONS

The present study has provided additional information on the anatomy and morphology of dorsolumbar spine synostosis with their embryological basis and clinical implications. We believe that the details are clinically important as they might be associated with neurological signs and symptoms.

Dumb bell shaped morphology of liver: an autopsy case report

Medicolegal autopsy on the dead body of an elderly female revealed that the liver was having some unusual shape. The left lobe of liver was bifid, having dumb bell type morphology. Also there were some furrows which were observed over the anterior surface of the liver. This type of morphological variant has not been reported hitherto. The clinicians should be aware of developmental morphological anomalies like in this case, as they might cause confusion during the procedures like biopsy, transplantation and lobectomies. We believe that this case report is important for the clinicians who are involved in the diagnosis and management of hepatic diseases. The knowledge is also enlightening for morphologists and embryologists.

Bilateral arterial variation in the upper extremity--an anatomical case report

We report a case of bilateral arterial variation in the upper extremities of a male cadaver. In the left upper extremity, it was observed that the ulnar artery was arising from axillary artery. This ulnar artery was superficial throughout its course at the medial aspect of the arm and forearm. It was highly tortuous and did not have any branches either in the arm or forearm. It ended as the superficial palmar arch in the palm. However the brachial artery entered the cubital fossa and divided into radial and common interosseus arteries. In contrast, the right upper extremity was having normal brachial artery which was terminated into the ulnar and radial arteries at the cubital fossa. However, there was an accessory brachial artery present at the arm and ended at the cubital fossa. We believe that these anatomical variations are because of abnormal developmental vascular pattern in the region. In clinical practice, accurate knowledge of the arterial variations of upper extremity is of considerable importance in case of reparative surgeries and fracture management. They are of interest to the vascular and plastic surgeons.

Incomplete discoid lateral meniscus: a case report

The variations of lateral meniscus include pathologic entities which vary in size, shape and attachment. In this manuscript, we report a case of discoid lateral meniscus which was observed in an embalmed fetal cadaver. It was an incomplete variety of the discoid meniscus and observed on the right side knee. The clinical implication of this discoid meniscus has been emphasized along with the review of literature. The morphological and embryologic details of the discoid lateral menisci are discussed.

Topography and morphological anatomy of nutrient foramina in human metacarpal bones and their clinical implications

PURPOSE

To study the morphological and topographic anatomy of nutrient foramina and to determine the foraminal index of metacarpal bones.

MATERIALS AND METHODS

The study consisted of 438 unpaired, human metacarpal bones of unknown age and sex. Nutrient foramina in each of the bones were grossly identified in relation to their number and location. The foraminal index was calculated by applying the Hughes formula. A digital vernier caliper was used to perform the measurements.

RESULTS

Among our specimens, 93.1% of metacarpals had single foramen, 2% had double foramina, 0.3% of the bones had triple foramina and in 4.6% of cases the foramen was absent. The mean foraminal indexes of the 1st, 2nd, 3rd, 4th and 5th metacarpal were 60.1, 53, 43.1, 43.7 and 45.9 respectively.

CONCLUSION

It was observed that the morphology and topography of nutrient foramina vary among different metacarpals. In 1st and 2nd metacarpals, foramina were more common at the medial surface and in other metacarpals, mostly seen on the lateral surface. The knowledge about these foramina is important in certain surgical procedures to preserve the circulation. This data is important to the plastic surgeon for microvascular bone transfer surgeries.

Morphological analysis and morphometry of the foramen magnum: an anatomical investigation

AIM

The objectives were to study the morphology of the foramen magnum in dry skulls and to evaluate its antero-posterior diameter, transverse diameter and the foramen magnum index.

MATERIAL AND METHODS

The foramen magna of 53 dry human cadaver skulls that were obtained from the neuroanatomy laboratory were examined. Different shapes of the foramen magnum were macroscopically noted and classified. The antero-posterior and transverse diameters were measured and the average foraminal index was calculated.

RESULTS

The foramen magnum shapes were determined as a round shape in 22.6% of cases, egg shape in 18.9%, tetragonal in 18.9%, oval in 15.1%, irregular in 15.1%, hexagonal in 5.6% and pentagonal in 3.8% of the cases. In 20.7% of skulls, the occipital condyle was observed to protrude into the foramen. The mean antero-posterior and transverse diameter of the foramen magnum was determined as 31 ± 2.4 mm and 25.2 ± 2.4 mm respectively. The average foramen magnum index was 1.2 ± 0.1.

CONCLUSION

The present study has determined the various shapes of foramen magnum and its morphometry. The data obtained may be of useful to the neurosurgeon in analyzing the morphological anatomy of craniovertebral junction. The findings are also enlightening for the anthropologists, morphologists and clinical anatomists.

Bone morphometry

OBJECTIVES

To compare anatomical measurements with that of radiological measurements.

BACKGROUND

The radiological measurements are commonly used in clinical practice. It is well known that the anatomical measurements are more accurate than radiological. The comparison of anatomicoradiological measurements is not reported hitherto.

METHODS

One human adult cadaveric femur bone was used for the present study. It was measured both anatomically and radiologically.

RESULTS

In digital X- ray measurements, the length from the upper lip of fovea capitis to the most prominent part of greater trochanter was 87.2 mms, from the upper most part of greater trochanter to the isthmus it was 147.9 mms, mediolateral width of medullary cavity at the isthmus was 8.9 mms, the mediolateral width at the distal root of lesser trochanter was 18.5 mms, anteroposterior width of medullary cavity at the isthmus was 11.5 mms, the anteroposterior width at the distal root of lesser trochanter was 16.8 mms. The same measurements were 91.2 mms, 154.6 mms, 11.8 mms, 19.7 mms, 11.9 mms and 18.5 mms when taken anatomically using the digital vernier caliper.

CONCLUSION

The present study showed that in all the parameters measured the radiological values were slightly lesser than the anatomical values. Considering the variations in the values, the implants can be designed for a particular case in orthopedic surgery. We believe that this study adds an important reference in the scientific literature (Tab. 1, Fig. 2, Ref. 5).

Cervical spine synostosis: an anatomical study with emphasis on embryological and clinical aspects

PURPOSE

The objectives were to study the anatomical features of fused vertebra in the cervical region.

MATERIALS AND METHODS

The study included 363 cervical vertebras which were macroscopically observed for the fusion and their morphology was studied.

RESULTS

Among our specimens, one fusion was observed between the C1 and C2 and the other was between C2 and C3. The mean anteroposterior diameter of normal atlas and axis were 42.1 +/- 0.9 mm and 46 +/- 0.5 mm respectively. The fused C1-C2 had 39 +/- 0.6 mm anteroposterior diameter. The mean lengths of anterior arch of normal atlas and body of axis were 16 +/- 0.9 mm and 23 +/- 0.7 mm respectively and the fused C1-C2 body length was 30 +/- 0.3 mm. The mean anteroposterior diameter of normal C2 and C3 vertebra were 46 +/- 0.5 mm and 47 +/- 0.8 mm respectively and of fused C2-C3 was 44 +/- 0.2 mm. The body length of C2 was 23 +/- 0.7 mm and C3 was 33 +/- 0.1 mm. The body length of fused C2-C3 was 36 +/- 0.8 mm.

CONCLUSION

The present study has provided additional information on the anatomy, morphology of cervical spine synostosis with their embryological basis and clinical implications.

Occipital condyle morphometry and incidence of condylus tertius: phylogenetic and clinical significance

PURPOSE

The objectives were to study the morphometry of occipital condyles and to find the incidence of third occipital condyle in Indian skulls.

MATERIALS AND METHODS

In the present study, 140 occipital condyles from 70 dry skulls were analysed. The length, width, height of occipital condyles, the anterior and posterior intercondylar distances was measured.

RESULTS

The average length, width and height of occipital condyle were 21.9 mm, 11.26 mm and 10.2 mm respectively. The average anterior and posterior intercondylar distances were 18.7 mm and 38.7 mm respectively. Among our specimens, 2 skulls (2.86%) had a third occipital condyle.

CONCLUSION

We believe that the data of the present study may provide anatomical reference to neurosurgeons and thus help in surgical procedures around the craniovertebral junction. The clinical and phylogenetic significance of the third occipital condyle has been discussed.

Peroneus quartus, an accessory muscle in human: case report and its clinical importance

The peroneus quartus is an accessory peroneal muscle seen in man. The term 'peroneus quartus' is often used to refer one or several of the accessory peroneal muscles. In this case, we report an unusual type of peroneus quartus which was originating from the muscular portion of the peroneus brevis and inserting onto the peroneus longus tendon. The clinical implications are emphasized with the morphological significance and literature review. The orthopedic surgeons and radiologists should be aware of the possible presence of this muscle not only because of its associated pathology, but also for its potential use in plastic surgeries.